Prevention & Early Detection

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Breast Imaging

Seattle Cancer Care Alliance physicians encourage all women over 40 to have regular annual mammograms. Simply being a woman and aging puts all women over age 40 at average risk for breast cancer. Not all mammograms are alike, and SCCA offers a comprehensive array of expertise and state-of-the-art diagnostic imaging technologies for women in the greater Seattle area including:

Digital Mammograms

SCCA is the only all-digital facility in Seattle and has the largest all-digital facility in Western Washington. Digital mammography captures X-ray images digitally which radiologists can read and manipulate right away for a more accurate diagnosis.

Recent studies have shown that digital mammography detects up to 28 percent more cancers than film mammography in women 50 years of age and younger, pre- and perimenopausal women, and in women with dense breast tissue. A 28 percent increase in accuracy means earlier detection, and most importantly, a better chance of a cure.

“This technology is better at finding breast cancers, gives fewer false positive results, and is more comfortable for the patient,” says Dr. Constance Lehman, M.D., Ph.D., director of Breast Imaging at SCCA.

At SCCA, we have two locations for mammography: The Women’s Center at the SCCA clinic and our Mobile Mammography Service. This convenient alternative will make regular visits to UW Medicine Neighborhood Clinics, Safeway stores, and other locations. Read more about the MammoVan.

Privacy, comfort, immediate results
Even though most breast lumps are benign, when a woman discovers a suspicious lump or other concern, it can be a stressful experience. At the Women’s Center we understand this.

Our breast imaging specialists provide interpretations and results from mammograms and other imaging studies immediately after each test. If additional imaging studies are needed, they are done that day as well.

There are three digital mammography rooms at the Women's Center, each with its own changing room. If further studies are needed, the Women’s Center offers emotional support, same-day biopsies, and a team of experts standing by to assist in every way possible.

Expert Radiologists

Our doctors are all board-certified radiologists who are also fellowship-trained specialists in breast imaging and who read thousands of mammograms a year. Numerous studies show that doctors who specialize in mammography are more accurate at interpreting the images when compared to physicians with less experience.

We recommend that when women get mammograms anywhere that they ask their doctor three questions:

  • Is the doctor a board-certified radiologist.
  • Do they specialize in mammography?
  • Do they read at least 2000 mammograms a year?

Magnetic Resonance Imaging (MRI)

According to a study led by SCCA's Dr. Lehman, MRI scans of women who were diagnosed with cancer in one breast detected over 90 percent of cancers in the other breast that were missed by mammography and clinical breast exam at initial diagnosis.

Given the established rates of mammography and clinical breast exams for detecting cancer in the opposite, or contralateral breast, adding an MRI scan to the diagnostic evaluation effectively doubled the number of cancers immediately found in these women.

The American College of Radiology Imaging Network (ACRIN) study, supported by the National Cancer Institute (NCI), part of the National Institutes of Health (NIH), appeared in the March 29, 2007 issue of the New England Journal of Medicine.

“We can now identify the vast majority of contralateral cancers at the time of a woman’s initial breast cancer diagnosis,” said Lehman, principal investigator of the ACRIN Breast MRI Trial, professor of radiology and director of breast imaging at the University of Washington and Seattle Cancer Care Alliance. “This means that instead of those women having another cancer diagnosis years after their initial treatment, we can diagnose and treat those opposite breast cancers at the time of the initial diagnosis.”

Researchers hope that with breast MRI’s strong ability to predict the absence of a tumor, they can avoid some unnecessary mastectomies and provide women with more reassurance that the breast is disease free.

“Although no imaging tool is perfect, if the MRI is negative, the chance of cancer in that breast is extremely low. A potential outcome that we would be delighted to see is fewer unnecessary bilateral mastectomies,” said Lehman.

In conjunction with this news, the American Cancer Society announced new recommendations for use of MRI for women at increased risk for breast cancer. An expert panel, of which Lehman is a member, recommended annual screening using MRI in addition to mammography for women with a 20-25 percent or greater lifetime risk of the disease.

Those include women who:

  • Have a first-degree relative with a BRCA 1 or 2 mutation and are untested,
  • Have a lifetime risk of breast cancer of 20-25 percent or more using standard risk assessment models
  • Received radiation treatment to the chest between ages 10 and 30, such as for Hodgkin Disease
  • Carry or have a first-degree relative who carries a genetic mutation in the TP53 or PTEN genes

“These guidelines are a critical step to help define who should be screened using MRI in addition to mammography, a question of significant importance as we discover women at very high risk of breast cancer can be diagnosed much earlier when combining the two technologies rather than mammography alone,” said Lehman.

More information:

Additional Diagnostic Tests

If there is an abnormality on your mammogram, you may be asked to have additional mammograms, an ultrasound, or possibly a stereotactic biopsyof the suspicious area.

  • Ultrasound

    Ultrasound can be used to evaluate lumps that are hard to see on a mammogram--to help distinguish between a tumor and a cyst for example--and as part of other procedures such as ultrasound-guided needle biopsy. Ultrasound is not used for routine breast cancer screening because it does not consistently detect certain early signs of cancer that can be seen on a mammogram.

    The Women's Center has three ultrasound rooms, each with state-of-the-art imaging equipment. As with our mammography, you will get the results of your ultrasound test immediately. 
     
  • Stereotactic biopsy

    A less-invasive alternative to a surgical biopsy, stereotactic biopsies radiologists collect small core tissue samples with a special needel and computer-aided equipment that pinpoints the suspected tumor. These samples are evaluated by a pathologist to see if cancer is present.

NEWS LINKS:

Studies about MRI and Breast Cancer

Dr. Constance Lehman, M.D., Ph.D.Dr. Constance Lehman, MD, PhD, director of Breast Imaging at SCCA led research that showed MRIs find more cancers in the other, or contralateral, breast of women newly diagnosed with the disease in one breast than mammography and clinical exams do. From this research, she co-authored new American Cancer Society guidelines regarding when women at high risk for breast cancer should have annual MRI scans in addition to annual mammograms.

In July 2007, Dr. Lehman won the Ladies Home Journal Breakthrough Award.

Watch a KOMO-TV interview with Dr. Lehman.

Breast cancer screening in community practices may be different from that in clinical trials. Read more on this topic and Dr. Lehman's studies published in the Journal of American Medical Association.